IP - ME.1.diabetes

CM Codes

Data Overview

13999 total codes in komodo_rii; 439 retained after n_claims > 500 filter.

CMS severity	n codes
No CC/MCC	283
CC	122
MCC	34

PCA Analysis

PC1 explains 37.1% of variance; PC1+PC2 together explain 54.4%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	n distinct rev codes	length of stay	organ system count	relative claim charge	n imaging lines	work rvu	n j code lines	icu
1	127.000	1501391.000	12.822	4.181	4.994	0.977	0.594	0.427	0.521	0.520
2	195.000	1042845.000	14.717	5.425	5.685	1.141	0.832	0.467	0.524	0.407
3	92.000	334858.000	16.106	6.572	5.830	1.384	0.974	0.556	0.572	0.417
4	25.000	55957.000	18.257	8.816	6.005	1.844	1.237	0.838	0.787	0.537

CMS Severity × intensity Tier

cms_severity	Tier 1	Tier 2	Tier 3	Tier 4	All
CC	14	56	43	9	122
MCC	5	6	9	14	34
No CC/MCC	108	133	40	2	283
All	127	195	92	25	439

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume	r_with_severity
avg_n_distinct_rev_codes	0.398	-0.075	0.439
avg_relative_claim_charge	0.394	-0.164	0.539
avg_length_of_stay	0.376	-0.165	0.443
avg_n_imaging_lines	0.331	-0.139	0.343
rate_transfusion	0.306	-0.018	0.471
avg_organ_system_count	0.256	-0.089	-0.078
rate_mechanical_ventilation	0.234	0.026	0.401
rate_or	0.230	-0.041	0.267
rate_multiple_or_days	0.215	0.034	0.143
avg_n_distinct_hcps	0.196	0.023	-0.021
avg_work_rvu	0.178	-0.207	0.193
rate_dialysis	0.160	0.113	0.339
avg_n_j_code_lines	0.158	-0.092	0.207
rate_icu	-0.034	0.050	0.154

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Misclassification Audit (N=10 samples)

Over-tiered: Tier 4, No CC/MCC (2 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
M6281	Muscle weakness (generalized)	No CC/MCC	4.539	4	1080	length of stay (+2.59), n distinct rev codes (+1.05), organ system count (+0.39)
G9389	Other specified disorders of brain	No CC/MCC	4.049	4	850	n imaging lines (+1.36), n distinct rev codes (+0.78), relative claim charge (+0.52)

Under-tiered: Tier 1, MCC (5 codes)

code	code_description	cms_severity	intensity_score	tier	n_claims	key_drivers
E1010	Type 1 diabetes mellitus with ketoacidosis without coma	MCC	-4.319	1	99668	organ system count (-0.75), n distinct rev codes (-0.66), length of stay (-0.64)
E1110	Type 2 diabetes mellitus with ketoacidosis without coma	MCC	-2.252	1	87500	organ system count (-0.48), length of stay (-0.38), or (-0.21)
E1310	Other specified diabetes mellitus with ketoacidosis without coma	MCC	-1.903	1	2336	organ system count (-0.53), length of stay (-0.41), n imaging lines (-0.38)
K226	Gastro-esophageal laceration-hemorrhage syndrome	MCC	-1.824	1	850	length of stay (-0.50), organ system count (-0.27), n imaging lines (-0.26)
E1100	Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)	MCC	-1.680	1	20411	organ system count (-0.31), length of stay (-0.26), or (-0.23)

Top Codes by Tier

Tier 1 (n=127 codes)

code	Description	CMS severity	Score	N claims	Key drivers
L97412	Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed	CC	-1.296	1034	n distinct hcps (-0.60), multiple or days (+0.46), n distinct rev codes (-0.42)
K219	Gastro-esophageal reflux disease without esophagitis	No CC/MCC	-1.316	37899	relative claim charge (-0.29), length of stay (-0.27), organ system count (+0.25)
E1021	Type 1 diabetes mellitus with diabetic nephropathy	No CC/MCC	-1.316	1122	n imaging lines (-0.30), n distinct rev codes (-0.30), length of stay (-0.27)
F10239	Alcohol dependence with withdrawal, unspecified	CC	-1.351	1661	length of stay (-0.26), organ system count (-0.18), transfusion (-0.16)
F250	Schizoaffective disorder, bipolar type	No CC/MCC	-1.357	1196	n distinct rev codes (-0.50), length of stay (+0.36), n imaging lines (-0.36)
I152	Hypertension secondary to endocrine disorders	No CC/MCC	-1.376	1602	relative claim charge (-0.31), length of stay (-0.27), n distinct rev codes (-0.22)
E10649	Type 1 diabetes mellitus with hypoglycemia without coma	No CC/MCC	-1.388	13790	organ system count (-0.31), n distinct rev codes (-0.25), n imaging lines (-0.19)
E10319	Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema	No CC/MCC	-1.399	3445	n imaging lines (-0.34), length of stay (-0.32), n distinct rev codes (-0.30)
K760	Fatty (change of) liver, not elsewhere classified	No CC/MCC	-1.401	8386	length of stay (-0.37), transfusion (-0.21), n distinct rev codes (-0.20)
K860	Alcohol-induced chronic pancreatitis	CC	-1.426	1250	length of stay (-0.25), multiple or days (-0.21), or (-0.18)

Tier 2 (n=195 codes)

code	Description	CMS severity	Score	N claims	Key drivers
I959	Hypotension, unspecified	No CC/MCC	0.972	8548	n distinct rev codes (+0.23), relative claim charge (+0.16), n j code lines (+0.16)
I951	Orthostatic hypotension	No CC/MCC	0.957	2363	n imaging lines (+0.36), length of stay (+0.29), n distinct rev codes (+0.28)
I440	Atrioventricular block, first degree	No CC/MCC	0.942	988	multiple or days (+0.41), n distinct hcps (+0.22), n distinct rev codes (+0.21)
I739	Peripheral vascular disease, unspecified	No CC/MCC	0.930	1834	work rvu (+0.64), multiple or days (+0.52), length of stay (+0.30)
I69354	Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side	CC	0.929	3090	n imaging lines (+0.42), n distinct rev codes (+0.32), length of stay (+0.22)
I4892	Unspecified atrial flutter	CC	0.921	2790	n distinct rev codes (+0.35), relative claim charge (+0.26), length of stay (+0.21)
I471	None	CC	0.921	847	n distinct rev codes (+0.30), n distinct hcps (+0.29), multiple or days (-0.21)
B951	Streptococcus, group B, as the cause of diseases classified elsewhere	No CC/MCC	0.920	1657	or (+0.55), n distinct hcps (+0.33), organ system count (+0.24)
L02416	Cutaneous abscess of left lower limb	CC	0.919	685	or (+0.69), relative claim charge (+0.24), n j code lines (+0.12)
L97429	Non-pressure chronic ulcer of left heel and midfoot with unspecified severity	CC	0.916	3288	multiple or days (+0.39), length of stay (+0.27), or (+0.25)

Tier 3 (n=92 codes)

code	Description	CMS severity	Score	N claims	Key drivers
K921	Melena	CC	3.782	893	transfusion (+1.45), relative claim charge (+0.78), n distinct rev codes (+0.47)
M6282	Rhabdomyolysis	CC	3.718	2289	n imaging lines (+0.89), relative claim charge (+0.76), n distinct rev codes (+0.76)
L89152	Pressure ulcer of sacral region, stage 2	No CC/MCC	3.713	1083	length of stay (+0.90), n distinct rev codes (+0.61), relative claim charge (+0.53)
K7682	Hepatic encephalopathy	No CC/MCC	3.623	682	multiple or days (+0.65), transfusion (+0.63), n distinct rev codes (+0.53)
K567	Ileus, unspecified	CC	3.587	772	relative claim charge (+1.11), length of stay (+0.75), n distinct rev codes (+0.58)
D689	Coagulation defect, unspecified	CC	3.472	747	transfusion (+0.96), relative claim charge (+0.72), n distinct rev codes (+0.63)
I96	Gangrene, not elsewhere classified	CC	3.450	2106	or (+0.74), multiple or days (+0.66), length of stay (+0.55)
J159	Unspecified bacterial pneumonia	MCC	3.405	782	relative claim charge (+0.99), n distinct rev codes (+0.62), length of stay (+0.43)
D500	Iron deficiency anemia secondary to blood loss (chronic)	No CC/MCC	3.397	779	transfusion (+1.81), n distinct rev codes (+0.35), relative claim charge (+0.33)
I3139	Other pericardial effusion (noninflammatory)	No CC/MCC	3.322	938	n distinct rev codes (+0.71), relative claim charge (+0.65), n imaging lines (+0.47)

Tier 4 (n=25 codes)

code	Description	CMS severity	Score	N claims	Key drivers
J9600	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	MCC	9.656	936	mechanical ventilation (+3.18), relative claim charge (+1.79), n distinct rev codes (+1.13)
D62	Acute posthemorrhagic anemia	CC	8.951	2936	transfusion (+3.44), relative claim charge (+1.48), n distinct rev codes (+1.08)
J690	Pneumonitis due to inhalation of food and vomit	MCC	8.532	3479	relative claim charge (+1.97), mechanical ventilation (+1.32), n distinct rev codes (+1.30)
J9602	Acute respiratory failure with hypercapnia	MCC	8.114	1339	mechanical ventilation (+1.91), relative claim charge (+1.76), n distinct rev codes (+1.25)
J9601	Acute respiratory failure with hypoxia	MCC	7.199	10515	relative claim charge (+1.52), mechanical ventilation (+1.34), n distinct rev codes (+1.17)
J90	Pleural effusion, not elsewhere classified	CC	6.508	2129	relative claim charge (+0.95), n distinct rev codes (+0.95), length of stay (+0.81)
I639	Cerebral infarction, unspecified	MCC	6.266	1096	n imaging lines (+1.91), n distinct rev codes (+1.19), relative claim charge (+1.04)
K922	Gastrointestinal hemorrhage, unspecified	CC	6.236	967	transfusion (+1.53), multiple or days (+1.05), relative claim charge (+0.69)
M4626	Osteomyelitis of vertebra, lumbar region	CC	6.133	863	length of stay (+1.27), n imaging lines (+1.24), relative claim charge (+0.90)
A419	Sepsis, unspecified organism	MCC	6.120	5738	relative claim charge (+1.25), n distinct rev codes (+0.82), length of stay (+0.65)

Key Driver Frequency

feature	count	pct
n distinct rev codes	230	52.400
relative claim charge	211	48.100
length of stay	203	46.200
organ system count	132	30.100
n imaging lines	125	28.500
multiple or days	83	18.900
or	73	16.600
n distinct hcps	69	15.700
transfusion	67	15.300
n j code lines	53	12.100
work rvu	39	8.900
dialysis	22	5.000
mechanical ventilation	10	2.300

PCS Codes

Data Overview

2884 total codes in komodo_rii; 46 retained after n_claims > 500 filter.

PCA Analysis

PC1 explains 51.8% of variance; PC1+PC2 together explain 63.6%.

Tier Clustering (k=4)

Tier Summary

tier	n_codes	n_claims	length of stay	n distinct rev codes	relative claim charge	organ system count	n imaging lines	mechanical ventilation	work rvu	n j code lines
1	11.000	12447.000	4.474	12.931	1.052	4.543	0.676	0.014	0.161	0.444
2	21.000	51752.000	6.610	17.720	1.732	5.197	1.022	0.047	0.421	0.639
3	13.000	20771.000	8.955	20.608	2.529	5.656	1.448	0.355	0.653	0.829
4	1.000	740.000	16.848	25.048	5.472	6.284	2.117	1.000	0.884	1.045

Feature Analysis

Feature Correlation

Feature Audit

	pc1_loading	r_with_volume
avg_n_distinct_rev_codes	0.350	0.126
avg_relative_claim_charge	0.344	0.110
avg_length_of_stay	0.340	0.149
avg_organ_system_count	0.337	0.206
avg_work_rvu	0.317	0.018
avg_n_j_code_lines	0.293	0.030
avg_n_imaging_lines	0.283	0.107
rate_mechanical_ventilation	0.255	0.135
rate_icu	0.241	-0.112
rate_or	0.214	0.025
rate_transfusion	0.204	0.130
rate_multiple_or_days	0.201	0.120
rate_dialysis	0.114	0.109
avg_n_distinct_hcps	0.014	0.064

Top 6 Tier-Discriminating Features

Bottom 6 Tier-Discriminating Features

Score Validation

Top Codes by Tier

Tier 1 (n=11 codes)

code	Description	Score	N claims	Key drivers
HZ2ZZZZ	DETOXIFICATION SERVICES FOR SUBSTANCE ABUSE TREATMENT	-2.400	964	n distinct rev codes (-0.41), length of stay (-0.32), organ system count (-0.29)
0HBMXZZ	EXCISION OF RIGHT FOOT SKIN, EXTERNAL APPROACH	-2.446	653	icu (-0.65), relative claim charge (-0.33), n distinct rev codes (-0.32)
8E0ZXY6	ISOLATION	-2.672	2035	work rvu (-0.40), n distinct rev codes (-0.38), organ system count (-0.32)
4A033R1	MEASUREMENT OF ARTERIAL SATURATION, PERIPHERAL, PERCUTANEOUS APPROACH	-3.049	651	work rvu (-0.48), n j code lines (-0.48), length of stay (-0.40)
3E03329	INTRODUCTION OF OTHER ANTI-INFECTIVE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.118	1474	work rvu (-0.43), n distinct rev codes (-0.42), n j code lines (-0.41)
3E02340	INTRODUCTION OF INFLUENZA VACCINE INTO MUSCLE, PERCUTANEOUS APPROACH	-3.285	999	organ system count (-0.63), n distinct rev codes (-0.44), length of stay (-0.36)
3E033VG	INTRODUCTION OF INSULIN INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.957	1414	organ system count (-0.82), n distinct rev codes (-0.64), length of stay (-0.45)
3E033GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-3.977	1247	organ system count (-0.66), n distinct rev codes (-0.60), work rvu (-0.49)
3E013GC	INTRODUCTION OF OTHER THERAPEUTIC SUBSTANCE INTO SUBCUTANEOUS TISSUE, PERCUTANEOUS APPROACH	-4.215	813	n distinct rev codes (-0.60), organ system count (-0.58), work rvu (-0.49)
3E0337Z	INTRODUCTION OF ELECTROLYTIC AND WATER BALANCE SUBSTANCE INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	-4.368	1093	n distinct rev codes (-0.58), n j code lines (-0.51), work rvu (-0.49)

Tier 2 (n=21 codes)

code	Description	Score	N claims	Key drivers
05HM33Z	INSERTION OF INFUSION DEVICE INTO RIGHT INTERNAL JUGULAR VEIN, PERCUTANEOUS APPROACH	0.932	665	icu (+0.25), multiple or days (+0.20), n j code lines (-0.16)
0DB98ZX	EXCISION OF DUODENUM, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	0.609	1051	n j code lines (+0.26), n distinct rev codes (+0.23), mechanical ventilation (-0.13)
0DB68ZX	EXCISION OF STOMACH, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	0.497	2483	n distinct rev codes (+0.26), mechanical ventilation (-0.12), work rvu (+0.11)
02HV33Z	INSERTION OF INFUSION DEVICE INTO SUPERIOR VENA CAVA, PERCUTANEOUS APPROACH	0.167	13988	or (+0.33), icu (-0.18), organ system count (+0.16)
0DB58ZX	EXCISION OF ESOPHAGUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	0.165	827	n distinct rev codes (+0.22), work rvu (-0.14), n j code lines (+0.14)
B548ZZA	ULTRASONOGRAPHY OF SUPERIOR VENA CAVA, GUIDANCE	0.086	1902	or (+0.28), organ system count (+0.20), icu (-0.18)
0DB78ZX	EXCISION OF STOMACH, PYLORUS, VIA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC, DIAGNOSTIC	0.060	1232	n distinct rev codes (+0.25), work rvu (-0.25), mechanical ventilation (-0.13)
5A09357	ASSISTANCE WITH RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS, CONTINUOUS POSITIVE AIRWAY PRESSURE	-0.039	3207	organ system count (+0.24), work rvu (+0.18), or (-0.15)
B2111ZZ	FLUOROSCOPY OF MULTIPLE CORONARY ARTERIES USING LOW OSMOLAR CONTRAST	-0.050	1366	work rvu (+0.31), n distinct rev codes (+0.25), or (-0.18)
05HC33Z	INSERTION OF INFUSION DEVICE INTO LEFT BASILIC VEIN, PERCUTANEOUS APPROACH	-0.068	1179	multiple or days (+0.38), or (+0.27), n j code lines (+0.18)

Tier 3 (n=13 codes)

code	Description	Score	N claims	Key drivers
5A1945Z	RESPIRATORY VENTILATION, 24-96 CONSECUTIVE HOURS	4.614	2144	mechanical ventilation (+0.81), n distinct rev codes (+0.60), relative claim charge (+0.55)
0BH17EZ	INSERTION OF ENDOTRACHEAL AIRWAY INTO TRACHEA, VIA NATURAL OR ARTIFICIAL OPENING	4.570	3376	mechanical ventilation (+0.72), relative claim charge (+0.59), n distinct rev codes (+0.53)
009U3ZX	DRAINAGE OF SPINAL CANAL, PERCUTANEOUS APPROACH, DIAGNOSTIC	3.612	988	n imaging lines (+0.84), length of stay (+0.57), relative claim charge (+0.56)
0JH63XZ	INSERTION OF TUNNELED VASCULAR ACCESS DEVICE INTO CHEST SUBCUTANEOUS TISSUE AND FASCIA, PERCUTANEOUS APPROACH	3.494	1229	length of stay (+0.74), or (+0.56), organ system count (+0.49)
03HY32Z	INSERTION OF MONITORING DEVICE INTO UPPER ARTERY, PERCUTANEOUS APPROACH	3.373	1387	work rvu (+0.69), n j code lines (+0.46), icu (+0.42)
3E033XZ	INTRODUCTION OF VASOPRESSOR INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.970	1073	work rvu (+0.46), icu (+0.42), organ system count (+0.39)
02H633Z	INSERTION OF INFUSION DEVICE INTO RIGHT ATRIUM, PERCUTANEOUS APPROACH	2.494	1052	length of stay (+0.40), work rvu (+0.36), n j code lines (+0.34)
0W9G3ZZ	DRAINAGE OF PERITONEAL CAVITY, PERCUTANEOUS APPROACH	2.428	758	multiple or days (+0.86), or (+0.44), n j code lines (+0.36)
30233N1	TRANSFUSION OF NONAUTOLOGOUS RED BLOOD CELLS INTO PERIPHERAL VEIN, PERCUTANEOUS APPROACH	2.408	4152	transfusion (+1.15), organ system count (+0.37), length of stay (+0.29)
5A1935Z	RESPIRATORY VENTILATION, LESS THAN 24 CONSECUTIVE HOURS	1.956	1196	mechanical ventilation (+0.81), icu (+0.37), organ system count (+0.32)

Tier 4 (n=1 codes)

code	Description	Score	N claims	Key drivers
5A1955Z	RESPIRATORY VENTILATION, GREATER THAN 96 CONSECUTIVE HOURS	8.101	740	relative claim charge (+1.51), length of stay (+1.39), mechanical ventilation (+0.81)

Key Driver Frequency

feature	count	pct
n distinct rev codes	22	47.800
work rvu	21	45.700
organ system count	17	37.000
n j code lines	17	37.000
or	15	32.600
relative claim charge	10	21.700
length of stay	9	19.600
icu	8	17.400
mechanical ventilation	7	15.200
n imaging lines	4	8.700
multiple or days	4	8.700
dialysis	2	4.300
transfusion	2	4.300